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Ann R Coll Surg Engl. 2009 September; 91(6): 513–514.
PMCID: PMC2966206
Technical Notes and Tips
Bruce Campbell, Section Editor

The One-Handed Laparoscopic Knot Technique: The Nott Technique

BACKGROUND

Laparoscopic operations such as colectomy, appendicectomy and placement of peritoneal dialysis catheter have been described using a two laparoscopic port technique (one camera port and one working port).13 Intracorporeal knot tying is traditionally performed using two instruments, requiring three ports (one camera port and two working ports).4 This technical note describes the method of intracorporeal knot formation using only one instrument, and thus two ports.

TECHNIQUE

The needle is passed through the defect and secured within the anterior abdominal wall opposite the instrument port (Fig. 1). The tail of the suture is passed over and backwards to the bight (Fig. 2). Ensure the bight is under tension as this will provide counter traction for tying. The instrument is passed through the loop and pulls the tail through (Fig. 3), forming a square knot. Repeated throws secure the knot down.

Figure 1
Needle secured within the anterior abdominal wall.
Figure 2
Tail passed backwards and over the bight. Ensure the bight is under tension.
Figure 3
The tail being pulled through the loop, with the needle secured to the anterior abdominal wall.

DISCUSSION

The technique describes laparoscopic intracorporeal knot tying using only one instrument, thereby eliminating the need for a third port. It is, therefore, most useful in two-port laparoscopic procedures (this method was employed in a diagnostic laparoscopy) and potentially when access with two instruments is difficult. Polyfilament sutures are most suited, as it allows easy manipulation of the tail end. Prolene sutures have a memory and, therefore, it can be difficult to throw the tail end of the suture over the bight. Additionally, by securing the needle to anterior abdominal wall, accidental damage to structures is minimised. We believe the method described is simple to master and quick to execute.

References

1. Al-Hashemy AM, Seleem MI, Al-Ahmary AM, Bin-Mahfooz AA. A two-port laparoscopic placement of peritoneal dialysis catheter. 2004;15:144–8. [PubMed]
2. Shemesh E, Shemesh S, Garber HI, Zmora O. A technique for laparoscopic-assisted colectomy using two ports. 2004;8:245–9. [PMC free article] [PubMed]
3. Khan A. Two-port laparoscopically assisted appendectomy in a child with use of the ultrasonically activated Endo-shear. 2003;7:193–7.
4. Murphy D. Endoscopic suturing and knot tying: theory into practice. 2001;234:607–12. [PubMed]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England